Low‐Density Lipoprotein Apheresis for Focal Glomerular Sclerosis

Yorioka, Noriaki; Taniguchi, Yoshihiko; Nishida, Yasuhiro; Okushin, Sayuri; Amimoto, Dai; Yamakido, Michio

doi:10.1111/j.1744-9987.1997.tb00058.x

Cited by 7 publications

(6 citation statements)

References 4 publications

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“… 15 found no effect of age on outcome, whereas previously published case studies reported remission from INS after apheresis in patients younger than 50 years. 12 , 13 , 14 Our data suggest that, regardless of the patient’s age, intensive rescue therapy by apheresis should be considered in patients with INS.…”

Section: Discussionmentioning

confidence: 75%

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Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys

Moret

Ganea

Dao

et al. 2021

Kidney International Reports

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Background Apheresis is the gold standard for idiopathic nephrotic syndrome (INS) relapse after transplantation, but it remains unknown whether such treatment is useful for adults with refractory INS on native kidneys. Methods This retrospective study included patients older than 16 years with biopsy-proven refractory (persistent nephrotic syndrome on corticosteroids plus at least 1 immunosuppressive drug) INS treated by apheresis and followed for at least 3 months. Results Between September 1997 and January 2020, 21 patients (focal segmental glomerulosclerosis: 12, minimal change nephrotic syndrome: 9, men: 67%, median age: 34 years) were identified. At last follow-up (12 months), 7 of 21 patients were in complete or partial remission. Remission was associated with older age (51 vs. 30 years, P = 0.05), lower proteinuria (3.9 vs. 7.3 g/d, P = 0.03), and lower estimated glomerular filtration rate (eGFR) (28.0 vs. 48.5 ml/min per 1.73 m 2 , P = 0.05) at apheresis. The need for dialysis before apheresis (odds ratio [OR] 22.0 [1.00–524], P = 0.026), age ≥50 years (OR: 22.6 [1.00–524], P = 0.006), a marked (>4.5 g/d) decrease in proteinuria (OR: 9.17 [1.15–73.2], P = 0.041), and a short (<12 months) time between diagnosis and apheresis (OR: 10.8 [1–117], P = 0.043) were significantly associated with remission. Three of 7 patients in remission who were initially on dialysis became dialysis-free; by contrast, none of the 14 patients without remission was initially on dialysis, but 5 of 14 had become dialysis-dependent ( P = 0.01). Conclusion Apheresis may result in remission in adult patients with refractory INS, particularly in those at risk of renal failure, with limited sensitivity to medical treatments, if apheresis is initiated within a year of diagnosis.

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Section: Discussionmentioning

confidence: 75%

“…Most of the available data originate from Japan and relate to patients with low-density lipoprotein (LDL)-apheresis. 12 , 13 , 14 , 15 , 16 …”

mentioning

confidence: 99%

Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys

Moret

Ganea

Dao

et al. 2021

Kidney International Reports

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“…As shown in Table 1 , regarding EPT modality, LDL-A was performed in 61 (59%) patients, followed by PE ( n = 31, 30%), IA ( n = 10, 10%), and LCAP ( n = 2, 2%). LDL-A was performed with a median of 9 sessions (IQR 8, 11) over 4.5 weeks (IQR 4, 5.5) in 3 case report studies [ 21 , 26 , 27 ], 9.6 ± 2.7 sessions in a case series study [ 34 ], and an average of 9.6 sessions per patient in another case series study [ 30 ]. PE was performed with a median of 6.5 sessions (IQR 4.5, 14.5) over 2 weeks (IQR 2, 19) in 2 case series and 2 case reports [ 17 , 18 , 23 , 25 ], 14 sessions (IQR 10, 23) over 6 weeks in a case series [ 31 ], and 35 sessions over 2 years and 88 sessions over 18 months in 2 case report studies [ 28 , 29 ], respectively.…”

Section: Resultsmentioning

confidence: 99%

“…CR and PR were defined in 5 studies ( n = 56 patients), though definitions differed [ 17 , 18 , 31 , 34 , 36 ]. In the other 9 studies ( n = 15 patients), CR and PR were not described and defined; we determined CR and PR by change in proteinuria levels based on its description in the articles [ 22–24 , 27–29 , 32 , 33 ]. In these patients, CR was defined as a reduction of baseline proteinuria to urine protein excretion of less than 0.3 g per 24 h and PR as a reduction of baseline proteinuria to urine protein excretion of 0.3 to 3 g per 24 h and 50% reduction in proteinuria.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of extracorporeal plasma therapy for adult native kidney patients with Primary FSGS: a Systematic review

et al. 2023

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Purpose This study aimed to assess efficacy of extracorporeal plasma therapy (EPT), including plasmapheresis (PE), immunoadsorption (IA), low-density lipoprotein apheresis (LDL-A), and lymphocytapheresis (LCAP) for adult native kidney patients with primary focal segmental glomerulosclerosis (FSGS). Methods A literature search was conducted using MEDLINE, EMBASE and Cochrane Databases through August 2022. Studies that reported outcomes of EPT in adult native kidneys with primary FSGS were enrolled. Results 18 studies with 104 therapy-resistant or refractory primary native FSGS patients were identified. Overall EPT response rate was 56%, with long-term benefit of 46%. Of the 101 non-hemodialysis (HD) patients, 54% achieved remission, with 30% complete remission (CR) and 23% partial remission (PR). Of 31 patients with PE, response rate was 65%; CR and PR rates were 27% and 37% in 30 non-HD patients. Of 61 patients with LDL-A, the response rate was 54%; CR and PR rates were 41% and 3% in 29 non-HD patients. Of 10 patients with IA, response rate was 40%. Of 2 patients with LCAP, 1 achieved CR, and one developed renal failure. All 3 HD patients showed increase in urine output and gradual decrease in urine protein excretion following PE ( n = 1) or LDL-A ( n = 2). 2 of 3 HD patients ultimately discontinued dialysis. Conclusion EPT with immunosuppressive therapy showed benefit in some patients with refractory primary FSGS, and PE appeared to have a higher response rate.

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“…Liposorber therapy on FGS patients in Japan is administered as a single course of 12 treatments in patients where conventional pharmacotherapy is ineffective and the nephrotic condition persists. Many reports have examined therapeutic effects such as a decrease in urinary protein due to the normalization of hyperlipidemia, improvement in creatinine clearance and serum proteins, and shortening of the duration needed for relief from the nephrotic syndrome (20,21). Macrophages are thought to be strongly involved in FGS pathology, and reports have suggested that Liposorber therapy inhibits the infiltration of macrophages into glomeruli of the kidneys (22).…”

Section: Clinical Applicationsmentioning

confidence: 99%

Blood Purification Therapies Using Dextran Sulfate Cellulose Columns Liposorber and Selesorb

2003

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Liposorber is a column used for plasma purification that adsorbs low-density lipoproteins with high selectivity, while Selesorb is a column that selectively adsorbs anti-DNA antibodies, anticardiolipin antibodies, and immune complexes. Both columns are packed with carriers, where a dextran sulfate ligand is bound to porous cellulose beads. Liposorber is used to treat familial hypercholesterolemia (FH), peripheral arterial disease (PAD), and focal segmental glomerulosclerosis (FGS): Selesorb is used to treat systemic lupus erythematosus (SLE). Treatment utilizing both columns is being used effectively in patients with refractory disease that is resistant to pharmacotherapy.

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Low‐Density Lipoprotein Apheresis for Focal Glomerular Sclerosis

Cited by 7 publications

References 4 publications

Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys

Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys

Efficacy of extracorporeal plasma therapy for adult native kidney patients with Primary FSGS: a Systematic review

Blood Purification Therapies Using Dextran Sulfate Cellulose Columns Liposorber and Selesorb

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